Thursday, January 5, 2012

Echoes of Navy Medicine's Past: World War II, Pacific Theater

December 7, 1941 still represents the U.S. Navy’s greatest disaster. In just over two hours much of the Pacific Fleet had been destroyed or seriously damaged. Even before the last Japanese aircraft had disappeared over the horizon, what the raiders had accomplished by their surprise attack was catastrophic. The pride of the fleet—seven battleships that once projected U.S. might and prestige—either lay on the bottom or were too crippled to be of any immediate use. Bombs, torpedoes, and machine guns had taken a terrible toll, with the Navy alone losing 2,008 men.

The wounded and severely burned survivors of the attack required immediate treatment, and Navy medical personnel were on the scene to provide that care. Navy medicine was represented at Pearl Harbor by a naval hospital, a partially assembled base hospital, and USS Solace (AH-5), the Navy’s newest hospital ship. Heroic efforts to save lives by the men and women who manned these facilities began minutes after the first Japanese bomb fell and never waned until the last casualty was tended to.

Physicians, nurses, and hospital corpsmen on duty at Naval Hospital Pearl Harbor performed emergency surgery, treated burns, and comforted the dying. The same scene played out aboard USS Solace, which lay at anchor just beyond “Battleship Row.” Oil-soaked sailors plucked from the harbor were taken to the hospital ship for treatment.

If the ferocity of the Japanese onslaught that followed Pearl Harbor left American forces reeling, isolated, and with scant hope of reinforcement, as an institution Navy medicine was equally stretched. Possessing only limited resources and with a presence only in Hawaii, the Philippines, Guam, a few small installations, and aboard the few vessels of the Asiatic Fleet, Navy medical personnel were hard pressed to treat patients as the Japanese rolled through the Pacific conquering everything before them. On 8 December 1941, World War II came to the Philippines when Japanese bombers hit Clark and Nichols Fields.

Two days later enemy bombers returned, this time destroying the Cavite Navy Yard and killing and maiming scores of Americans and Filipinos. Personnel at the nearby Cañacao Naval Hospital worked frantically to treat the wounded.

Japanese soldiers who landed on Philippine beaches in late December 1941 overwhelmed the ill-equipped and outnumbered Americans and Filipinos. By the time Japanese forces entered Manila on 1 January after GEN Douglas MacArthur declared it an open city, its battered defenders had already withdrew to the Bataan Peninsula to make their last stand.

As food and medicine ran out, disease took its toll among Bataan’s defenders. The lack of quinine for the treatment of malaria was critical, and without it many men came down with the disease. Nearly everyone suffered debilitating weakness from dysentery. Overwhelmed, Bataan’s 75,000 defenders finally surrendered in April 1942.

But out in Manila Bay, the island fortress of Corregidor still remained defiant despite a lack of food and ammunition. After a month of heavy bombardment and finally landings by Japanese forces, Corregidor surrendered on May 6th. American power in the Far East had been extinguished. Yet despite the new reality, the hundreds of medical professionals captured in the Pacific were still “Doc” or “Nurse” to their fellow POWs. Without hospitals or supplies, they continued to practice their healing art, often under unimaginable circumstances.

Some 10,000 surrendered at Corregidor after thousands of captured Americans and Filipinos had already died on the infamous Bataan Death March. Those who survived Japanese brutality and neglect now faced Japanese prison camps. For the approximately 17,000 Americans and 12,000 Filipino scouts who surrendered in the Philippines, the real ordeal had barely begun. Torture, forced labor, starvation and death became the norm in Japanese POW camps throughout the Far East.

Even though physicians and corpsmen did the best they could to provide health care in these camps, they had virtually no drugs or instruments. Malaria and dengue fever were endemic. Sanitation was non-existent and almost everybody had dysentery. Many came down with deficiency diseases like scurvy, optic neuritis, and beriberi. By the summer of 1942 the Japanese held over 50,000 prisoners, 20,000 of whom were Americans.

Eleven of these were Navy nurses from the Cañacao Naval Hospital. They spent the war in internment camps at Santo Tomás in Manila and then at Los Baños in the Philippine countryside, where they were finally liberated in February 1945. Many of their male colleagues never made it home, either succumbing to disease, starvation, brutal treatment by their captives, or dying by “friendly fire” when the so-called hell ships in which they were being transported to Japan were sunk by American submarines or aircraft.

Despite the fate of these unfortunate POWs, the war against Japan was in full swing by the summer of 1942. Reconquering territory held by the enemy was the priority and it meant fighting island by island, each one a stepping stone to Tokyo. Organizing the Navy Medical Department to care for the thousands of Navy and Marine Corps casualties generated by opposed amphibious landings, make them well, and then return them to duty was the major priority. It was in the Pacific war that Navy medicine faced its greatest challenge dealing with the aftermath of intense, bloody warfare fought far from fixed hospitals. This put enormous pressure on medical personnel closest to the front and forced new approaches to primary care and evacuation.

The most dramatic and demanding duty a Navy hospital corpsman could have was with Marine Corps units in the field. Because the Marine Corps has always relied upon the Navy for medical support, corpsmen accompanied the leathernecks and suffered the brunt of combat themselves. Many of them went unarmed, reserving their carrying strength for medical supplies.

Navy corpsmen were the first critical link in the evacuation chain. From the time a Marine was hit on an invasion beach at Guadalcanal, Tarawa, Saipan, Iwo Jima, and a host of other Pacific islands, the corpsman braved enemy fire to render aid. He applied a battle dressing, administered morphine, and tagged the casualty. If he were lucky, the corpsman might commandeer a litter team to move the casualty out of harm’s way and on to a battalion aid station or a collecting and clearing company for further treatment. This care would mean stabilizing the patient with plasma, serum albumin, and, later in the war, whole blood. In some cases, the casualty was then moved to the beach for evacuation. In others, the casualty was taken to a divisional hospital, where doctors performed further stabilization, including emergency surgery if needed.

Navy hospital ships, employed mainly as ambulances, provided first aid and some surgical care for the casualties’ needs while ferrying them to base hospitals in the Pacific or back to the United States for definitive care. As the war continued, air evacuation helped carry the load. Trained Navy nurses and corpsmen staffed the evacuation aircraft.

Enabling the Navy and Marine Corps to defeat the enemy also meant recognizing that disease more often than enemy action threatened this goal. During the battle for Guadalcanal in the Solomons, malaria caused more casualties than Japanese bullets. Shortly after the landings, the number of patients hospitalized with malaria exceeded all other diseases. Some units suffered over a 100 percent casualty rate with personnel being hospitalized more than once. Only when malaria and other tropical diseases were brought to heel could the Pacific war be won.

The Pacific war was massive in scale, fought over vast stretches of ocean. Fleets engaged one another often many miles distant from one another. Carrier-based aircraft were the surrogates that sought out the enemy and delivered the ordnance. U.S. Navy task forces consisting of carriers, battleships, cruisers, destroyers, and destroyer escorts required their own medical support and each of these vessels had among their crews corpsmen, physicians, and, aboard the larger vessels, dentists as well. By October 1945 the fleet numbered over 7,000 vessels from landing craft and auxiliaries to the Essex class carriers and Iowa class battleships. The hundreds of vessels smaller than destroyers had their corpsmen to be sure, but the larger vessels rated physicians, corpsmen, dentists, fully equipped sick bays, battle dressing stations, and usually an operating room. The standard medical complement for a 7,250-ton escort carrier was one medical officer, a flight surgeon for the embarked air group, a dentist, and about 13 corpsmen. A much larger 27,100-ton Essex class carrier like USS Franklin (CV-13) boasted four physicians augmented by a flight surgeon, 3 dentists, and 31 corpsmen. During routine operations, physicians and corpsmen serving aboard vessels in the South Pacific encountered and treated heat and humidity related maladies exacerbated by confinement without air conditioning—heat exhaustion and stroke, fungus infections, heat rash, and breathing disorders.

The encounters between Japanese and American fleets were most often brutal affairs with many casualties generated in both brief and sustained actions. Torpedoes, bombs, and armor-piercing shells produced horrendous wounds. When the Japanese launched their kamikaze terror campaign, medical personnel were often overwhelmed. A single suicide plane plunging through the flight deck of an aircraft carrier and igniting fueled and armed aircraft produced hundreds of burn victims within seconds. As the fighting drew ever closer to the Japanese home islands in early 1945, thousands of sailors were killed and wounded by these human-guided missiles.

Navy medical personnel also served aboard submarines that prowled the Pacific destroying thousands of tons of Japanese shipping. Among its crew, each submarine carried one highly trained corpsman or pharmacist’s mate, as they were then called. (Physicians were not assigned to submarines.) Indeed, one of the most dramatic stories to come out of World War II recounted an emergency appendectomy performed by a 23-year-old corpsman as his submarine, USS Seadragon, cruised submerged in enemy waters. The corpsman, Wheeler B. Lipes, successfully removed the badly infected appendix and saved his patient. This heroic story not only highlighted the skill and resourcefulness of Navy corpsmen, but also buoyed the nation’s spirits early in the war when news from the Pacific was anything but encouraging.

When World War II finally ended with the Japanese surrender aboard USS Missouri (BB-63) on 2 September 1945, the U.S. Navy had become the largest maritime force the world had ever known. And the Medical Department which supported that Navy would itself never again have as many personnel, or staff as many hospitals, dispensaries, and hospital ships as it did on that day.

What followed victory was rapid demobilization as soldiers, sailors, airmen, and Marines in the Pacific theater headed home. Helping get them there were aircraft carriers, battleships, LSTs, and Navy hospital ships—all of which became troop transports in what was called “Operation Magic Carpet.”

Disclaimer

The opinion or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the U.S. Department of Defense, the U.S. Navy or the Bureau of Medicine & Surgery.